Theory of CIMT

Constraint induced movement therapy (“CI therapy” or “CIMT”) is a form of rehabilitation for the upper limb with evidence based links to theories of neuroplasticity and cortical reorganisation.

Constraint induced movement therapy was developed by Dr Edward Taub and his team in the USA. They worked with adults recovering from stroke with hemiplegia, who had limited use of their affected side in activities of daily living. Dr Taub’s team found that by restraining the stronger side and using the weaker side as much as possible alongside specific intensive exercises, they could make significant improvements in the amount and quality of movement of the upper limb over a short period of time. These results have been repeated in numerous studies including large multi-site randomised controlled trials, and similar results have since been demonstrated for children and adults with other neurological conditions with a hemiplegic presentation. See evidence base for more information on clinical trials.

Learned non-use: Constraint induced movement therapy is based on the theory of “learned non-use”. Taub et al theorised that when trying to use an affected upper limb the patient experiences negative feedback in the form of pain or failure at the task. They learn to compensate with their unaffected side instead and begin to develop a pattern of compensatory behaviour. Even when the initial central nervous system depression subsides and some motor recovery is possible, the patient continues to follow this new compensatory behaviour and fails to involve their affected upper limb – they “learn” not to use it.

Cortical Reorganisation: CIMT links in with theories of “use-dependent cortical reorganisation”, where the representational size of body parts on the cortex is explicitly linked with the amount the body part is used. In cases of learned non-use or developmental disregard, researchers have found the representation of the affected limb has decreased on the cortex.

Several studies have now shown that following a full constraint induced movement therapy programme the affected side has increased its representation on the cortex, and this increase remains on 6 month follow up. This has been demonstrated in adults following stroke, and in children with hemiplegia.

So CIMT does not just affect the strength and ability of the upper limb, but it also directly influences plasticity and cortical reorganisation. It is this combination that makes the treatment so powerful, and allows gains to carry over months, even years, after treatment has completed.

#CIMTFacts

Can you do CIMT one day a week?

Studies keep looking into diluted forms of CIMT. The results are never as substantial as those for 5 days a week intensity, so we stick to the evidence and only offer the programmes in full. For cortical reorganisation to occur you need prolonged focus on the affected limb – can you get that with just one session a week...?